What another Biden (Trump) presidency would mean for rising health care costs

President Joe Biden is counting on outrage over abortion restrictions to help drive turnout for his reelection. Former President Donald Trump is promising to take another swing at repealing Obamacare.

But around America’s kitchen tables, those are hardly the only health topics voters want to hear about in the 2024 campaigns. A new KFF tracking poll shows that health care tops the list of basic expenses Americans worry about — more than gas, food, and rent. Nearly 3 in 4 adults — and majorities of both parties — say they’re concerned about paying for unexpected medical bills and other health costs.

“Absolutely health care is something on my mind,” Rob Werner, 64, of Concord, New Hampshire, said in an interview at a local coffee shop in January. He’s a Biden supporter and said he wants to make sure the Affordable Care Act, also known as Obamacare, is retained and that there’s more of an effort to control health care costs.

The presidential election is likely to turn on the simple question of whether Americans want Trump back in the White House. And neither major party is basing their campaigns on health care promises.

But in the KFF poll, 80% of adults said they think it’s “very important” to hear presidential candidates talk about what they’d do to address health care costs — a subject congressional and state-level candidates can also expect to address.

“People are most concerned about out-of-pocket expenses for health care, and rightly so,” said Andrea Ducas, vice president of health policy at the Center for American Progress, a Washington, D.C.-based progressive think tank.

Here’s a look at the major health care issues that could help determine who wins in November.

Abortion

Less than two years after the Supreme Court overturned the constitutional right to an abortion, it is shaping up to be the biggest health issue in this election.

That was also the case in the 2022 midterm elections, when many voters rallied behind candidates who supported abortion rights and bolstered Democrats to an unexpectedly strong showing. Since the Supreme Court’s decision, voters in six states — including Kansas, Kentucky, and Ohio, where Republicans control the legislatures — have voted on state constitutional amendments regarding abortion access, and the side favoring abortion rights won in each case.

Polls show that abortion is a key issue to some voters, said Robert Blendon, a public opinion researcher and professor emeritus at the Harvard T.H. Chan School of Public Health. He said up to 30% across the board see it as a “personal” issue, rather than policy — and most of those support abortion rights.

“That’s a lot of voters, if they show up and vote,” Blendon said.

Proposals to further protect — or restrict — abortion access could drive voter turnout. Advocates are working to put abortion-related measures on the ballot in such states as Arizona, Florida, Missouri, and South Dakota this November. A push in Washington toward a nationwide abortion policy could also draw more voters to the polls, Blendon said.

A surprise ruling by the Alabama Supreme Court in February that frozen embryos are children could also shake up the election. It’s an issue that divides even the anti-abortion community, with some who believe that a fertilized egg is a unique new person deserving of full legal rights and protections, and others believing that discarding unused embryos as part of the in vitro fertilization process is a morally acceptable way for couples to have children.

Pricey prescriptions

Drug costs regularly rank high among voters’ concerns.

In the latest tracking poll, more than half — 55% — said they were very worried about being able to afford prescription drugs.

Related: Key health care takeaways from President Biden’s State of the Union speech

Biden has tried to address the price of drugs, though his efforts haven’t registered with many voters. While its name doesn’t suggest landmark health policy, the Inflation Reduction Act, or IRA, which the president signed in August 2022, included a provision allowing Medicare to negotiate prices for some of the most expensive drugs. It also capped total out-of-pocket spending for prescription drugs for all Medicare patients, while capping the price of insulin for those with diabetes at $35 a month — a limit some drugmakers have extended to patients with other kinds of insurance.

Drugmakers are fighting the Medicare price negotiation provision in court. Republicans have promised to repeal the IRA, arguing that forcing drugmakers to negotiate lower prices on drugs for Medicare beneficiaries would amount to price controls and stifle innovation. The party has offered no specific alternative, with the GOP-led House focused primarily on targeting pharmacy benefit managers, the arbitrators who control most Americans’ insurance coverage for medicines.

Costs of coverage

Health care costs continue to rise for many Americans. The cost of employer-sponsored health plans have hit new highs in the past few months, raising costs for employers and workers alike. Experts have attributed the increase to high demand and expensive prices for certain drugs and treatments, notably weight loss drugs, as well as to medical inflation.

Meanwhile, the ACA is popular. The KFF poll found that more adults want to see the program expanded than scaled back. And a record 21.3 million people signed up for coverage in 2024, about 5 million of them new customers.

Enrollment in Republican-dominated states has grown fastest, with year-over-year increases of 80% in West Virginia, nearly 76% in Louisiana, and 62% in Ohio, according to the Centers for Medicare & Medicaid Services.

Public support for Obamacare and record enrollment in its coverage have made it politically perilous for Republicans to pursue the law’s repeal, especially without a robust alternative. That hasn’t stopped Trump from raising that prospect on the campaign trail, though it’s hard to find any other Republican candidate willing to step out on the same limb.

“The more he talks about it, the more other candidates have to start answering for it,” said Jarrett Lewis, a partner at Public Opinion Strategies, a GOP polling firm.

“Will a conversation about repeal-and-replace resonate with suburban women in Maricopa County/?” he said, referring to the populous county in Arizona known for being a political bellwether. “I would steer clear of that if I was a candidate.”

Biden and his campaign have pounced on Trump’s talk of repeal. The president has said he wants to make permanent the enhanced premium subsidies he signed into law during the pandemic that are credited with helping to increase enrollment.

Republican advisers generally recommend that their candidates promote “a market-based system that has the consumer much more engaged,” said Lewis, citing short-term insurance plans as an example. “In the minds of Republicans, there is a pool of people that this would benefit. It may not be beneficial for everyone, but attractive to some.”

Biden and his allies have criticized short-term insurance plans — which Trump made more widely available — as “junk insurance” that doesn’t cover care for serious conditions or illnesses.

Entitlements are off-limits

Both Medicaid and Medicare, the government health insurance programs that cover tens of millions of low-income, disabled, and older people, remain broadly popular with voters, said the Democratic pollster Celinda Lake. That makes it unlikely either party would pursue a platform that includes outright cuts to entitlements. But accusing an opponent of wanting to slash Medicare is a common, and often effective, campaign move.

Although Trump has said he wouldn’t cut Medicare spending, Democrats will likely seek to associate him with other Republicans who support constraining the program’s costs. Polls show that most voters oppose reducing any Medicare benefits, including by raising Medicare’s eligibility age from 65. However, raising taxes on people making more than $400,000 a year to shore up Medicare’s finances is one idea that won strong backing in a recent poll by The Associated Press and NORC Center for Public Affairs Research.

Brian Blase, a former Trump health adviser and the president of Paragon Health Institute, said Republicans, if they win more control of the federal government, should seek to lower spending on Medicare Advantage — through which commercial insurers provide benefits — to build on the program’s efficiencies and ensure it costs taxpayers less than the traditional program.

So far, though, Republicans, including Trump, have expressed little interest in such a plan. Some of them are clear-eyed about the perils of running on changing Medicare, which cost $829 billion in 2021 and is projected to consume nearly 18% of the federal budget by 2032.

“It’s difficult to have a frank conversation with voters about the future of the Medicare program,” said Lewis, the GOP pollster. “More often than not, it backfires. That conversation will have to happen right after a major election.”

Addiction crisis

Many Americans have been touched by the growing opioid epidemic, which killed more than 112,000 people in the United States in 2023 — more than gun deaths and road fatalities combined. Rural residents and white adults are among the hardest hit.

Federal health officials have cited drug overdose deaths as a primary cause of the recent drop in U.S. life expectancy.

Republicans cast addiction as largely a criminal matter, associating it closely with the migration crisis at the U.S. southern border that they blame on Biden. Democrats have sought more funding for treatment and prevention of substance use disorders.

“This affects the family, the neighborhood,” said Blendon, the public opinion researcher.

Billions of dollars have begun to flow to states and local governments from legal settlements with opioid manufacturers and retailers, raising questions about how to best spend that money. But it isn’t clear that the crisis, outside the context of immigration, will emerge as a campaign issue.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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